1. Our team is a highly experienced team with a long history of working with clients
in the health sector. Our cross functional team of health specialists includes
clinicians and technical experts
Sandy Lawson
National Health & Aged Care leader
T +61 3 8320 2167
E sandy.lawson@au.gt.com
Scott Hartley
National Public Sector Health leader
T +61 3 8633 6143
E scott.hartley@au.gt.com
Jason Sorby
Partner Operational Advisory & Head of
Queensland Public Sector Health Group
T +61 7 3222 0310
E jason.sorby@au.gt.com
Gerry Meir
Partner, Cairns
T +61 7 4046 8800
E gerry.meir@au.gt.com
Rory Gregg
Partner Operational Advisory and Head of
NSW Public Sector Health Group
T +61 2 82697 2531
E rory.gregg@au.gt.com
Our clinical experts
Phil Pareezer
Senior Health Advisor, Queensland
T +61 7 3222 0276
E phil.pareezer@au.gt.com
Michael Roberts
Senior Health Advisor, Victoria
T +61 3 8663 6011
E michael.roberts@au.gt.com
Making it workSustainable solutions for rural and remote primary healthcare
AUGUST 2014
Grant Thornton Australia Limited ABN 41 127 556 389 ACN 127 556 389
‘Grant Thornton’ refers to the brand under which the Grant Thornton member firms provide assurance, tax and advisory services to their clients and/or refers to one or more member firms,
as the context requires. Grant Thornton Australia Ltd is a member firm of Grant Thornton International Ltd (GTIL). GTIL and the member firms are not a worldwide partnership. GTIL and each
member firm is a separate legal entity. Services are delivered by the member firms. GTIL does not provide services to clients. GTIL and its member firms are not agents of, and do not obligate
one another and are not liable for one another’s acts or omissions. In the Australian context only, the use of the term ‘Grant Thornton’ may refer to Grant Thornton Australia Limited ABN 41 127
556 389 and its Australian subsidiaries and related entities. GTIL is not an Australian related entity to Grant Thornton Australia Limited.
Liability limited by a scheme approved under Professional Standards Legislation. Liability is limited in those States where a current scheme applies.
www.grantthornton.com.au
Our national team of specialists About Grant Thornton
Grant Thornton is one of the world's
leading organisations of independent
assurance, tax and advisory firms.
Grant Thornton Australia has more
than 1,040 people working in offices in
Adelaide, Brisbane, Cairns, Melbourne,
Perth and Sydney. We combine service
breadth, depth of expertise and industry
insight with people who have an
approachable "client first" mindset and a
broad commercial perspective.
More than 38,500 Grant Thornton
people, across over 100 countries,
are focused on making a difference to
clients, colleagues and the communities
in which we live and work. Through
this membership, we access global
resources and methodologies that
enable us to deliver consistently high
quality outcomes for key executives in
our clients.

2. MAKING IT WORK SUSTAINABLE SOLUTIONS FOR RURAL AND REMOTE PRIMARY HEALTHCARE | AUGUST 2014
Australia has long struggled with an uneven distribution of primary health care services. Urban
residents experience greater access to primary health care, despite the fact that rural and remote
residents generally experience poorer health than their urban counterparts. For example this has
been exacerbated by the mining boom, which has increased the demand for primary health care
in some mining areas.
CURRENTCAREMODELSSUSTAINABLESOLUTIONS
These mining communities are situated in areas that have traditionally found it
difficult to grow their primary health care workforce for reasons including:
Work related challenges
• Availability and affordability of primary health care infrastructure
• Greater administrative burden and difficulty in providing after hours care
• Long or inflexible working hours placing a strain on well-being
• Mentoring and support from other health care professionals
• Less professional recognition
• Limited opportunities for professional development
Lifestyle challenges
• Availability and cost of housing
• Limited employment opportunities for spouses / partners
• Less time for rest and recreational activities
• Poorer social, cultural and recreational amenities and infrastructure
• Lack of family support
• Restricted childcare and school facilities
Despite the Australian Government’s efforts to attract more primary health care
workers to rural and remote areas through the provision of financial incentives,
the distribution has changed little over time. The challenge is to find more flexible,
sustainable, innovative, collaborative and locally appropriate solutions that address
the needs of the local community.
Source: AIHW, 2014
Snapshot of rural and
remote primary health care
in 2012 (Australian Institute
of Health and Welfare, 2014)
Remote/very remote
areas had 134.3 GPs
per 100,000 popula-
tion. The average age
of medical practition-
ers in remote/very
remote areas was
45.4
Of the people living
in outer regional
and remote areas,
23% felt they had
to wait longer than
acceptable for a GP
appointment
Nurse practitioners
are currently a small
group, numbering 624
(of which 169 were
in NSW, 155 in QLD,
116 in WA, 72 in VIC
and 58 in SA)
Nurses in very
remote areas worked
6.7 hours more on
average per week
compared to major
cities
People in remote
areas were 4.5 times
as likely as those in
major cities to travel
over one hour to see
a doctor
1
Traditional primary
health care model
• The conventional model
of primary health care
comprises a permanent,
dedicated doctor
service in all areas of
Australia.
• This model has
managed to remain
in most rural and
remote areas due
to the employment
of overseas-trained
doctors.
• The focus is still
on increasing the
number of stand-alone
doctors in rural and
remote areas, despite
continuous difficulties
with recruitment and
retention. This is not a
sustainable long-term
model.
A contestable primary
health care model
• Flying in (or driving in)
doctors from a larger
rural hub per a roster
offers greater access to
highly specialised care
for rural and remote
communities.
• These visiting services
need to be supported by
a core group of primary
health care providers
that are based in the
community.
• These services will
ideally be funded and
operated by private
providers (including
mining companies)
or in a public-private
partnership model that
ensures sustainability
and continuity of care in
the long run.
2
An agile and multi-
disciplinary practice
• Introducing multi-
disciplinary, community
owned (community
controlled in the
Aboriginal Health
area) practices, that
incorporate telehealth,
to rural areas will enable
more local ‘ownership’ of
the problem of retaining
and incentivising GPs
through community
involvement in reducing
isolation.
• These practices could
operate under a hub
and spoke model where
remote spoke services
are supported by larger
rural hub services.
• Rural practices also
require business support
to run sustainable
businesses.
Incentives to retain
rural workforces
• Various financial
incentives are currently
in place to entice
primary health care
workers to remain
in rural and remote
positions, however,
providing this type of
incentive alone may not
be a holistic solution,
as lifestyle is the main
driving factor in these
areas, not money.
• More tailored and
innovative solutions
need to be found to
address the problems
of loneliness, and
professional and social
isolation, which are
causes of mental health
issues for both the
community and primary
health care workers.
3
Integrated model of
care – the way of the
future
• A new rural and remote
primary health care
model should leverage
off the strengths of
rural communities
and promote greater
transparency and
stronger collaboration
between local
governments, doctors,
Allied Health Workers,
NPs, PAs and Aboriginal
Health Workers.
• Medicare funding is
needed to make the
employment of NPs
and PAs worthwhile, to
enable them to provide
after hours care, and to
reduce GP resistance
to alternative types of
primary health care
professionals.
Growing the primary
health care workforce
• Practice Nurses and
Nurse Practitioners
(NPs) are currently
operating in the rural
and remote areas of
various states, including
Queensland and WA,
where there is an uneven
distribution of doctors.
NPs are endorsed to
function autonomously
and collaboratively in an
advanced and extended
clinical role.
• Small scale trials for
Physician Assistants
(PAs) to work under the
supervision of GPs have
recently been conducted
in Queensland.
• NPs and PAs have the
potential to assist in the
provision of after hours
care services.
4
Increased internships in
rural hospitals
• While the creation
of rural and remote
medical schools is
important for attracting
students to rural and
remote areas, more
internship places need
to also be created
in rural hospitals so
students can continue
their postgraduate
training in these areas.
• This is particularly
important for retaining
graduating doctors who
are originally from rural
or remote communities,
and are more likely to
remain in the areas
where they grew up.
Attracting students
from rural areas
• Despite the stigma
attached to rural
schooling, the Australian
Government has made
a concerted effort in
recent years to not only
increase the overall
medical school intake,
but to also promote
rural and remote
medical training, and
establish a number
of rural and remote
medical schools
• The introduction of
bonded medical school
places, which was
designed to retain
students in rural and
remote areas post-
graduation, has been
ineffective due to the
option to ‘buy out’ of the
scheme.
5
More responsive
telehealth services
• Improving Internet
access and the number
of telehealth access
points will make
telehealth a more
seamless and attractive
treatment option, with
the ultimate goal being
home-based care which
is available 24/7.
• MBS item numbers need
to be made available for
GP patient consultations
where patients have to
travel a long distance to
see a GP.
• The shipping of
pharmaceuticals has the
potential to extend the
telehealth value chain
even further.
Existing telehealth /
telemedicine services
• Although telehealth
services have been
available in rural and
remote areas for the
past decade, a number
of access and equity
barriers have prevented
their uptake. These
include:
IT infrastructure,
equipment, tele-literacy,
accessibility, payment
methodology and
preference for the
traditional approach of
‘in-person’ care. MBS
item numbers are not
available for GP patient
consultations; they are
only available for GP
Specialist consultations.
Key Considerations